MEDICAL NUTRITION THERAPY IN ALIMENTARY TRACT DISORDERS
GASTROESOPHAGEAL REFLUX DISEASE
Gastroesophageal reflux disease (GERD) is a common digestive disorder, with estimated
prevalence between 10% and 20% in the Western world.
It is characterised by a relaxed or weakened lower esophageal sphincter, which is now open
and allowing reflux to occur.
Symptoms
● Symptoms of GERD include heartburn and regurgitation of stomach acid.
● Other symptoms may include abdominal pain, bad breath, epigastric pressure,
cough, sore throat, dental erosions, wheezing, or difficulty swallowing.
Over time, untreated GERD can lead to erosive esophagitis, pulmonary disease, esophageal
adenocarcinoma, Barrett’s esophagus, and peptic stricture.
Medical and surgical treatment
● Medical treatment of GERD typically involves the use of acid-suppressing
medications, such as proton-pump inhibitors (PPIs).
● If the patient’s symptoms do not improve with medical therapy, surgical options may
be considered.
● A Nissen Fundoplication is a procedure where the top portion of the stomach is
wrapped around the lower esophagus to improve the integrity of the lower
esophageal sphincter and reduce reflux.
● For morbidly obese patients, gastric bypass may be recommended as a treatment for
GERD.
Nutrition Assessment and intervention
● When a patient complains of reflux, it is helpful to get a detailed dietary recall in
order to assess any potential trigger foods in the diet.
● Foods that may cause increased reflux include fatty foods, chocolate, alcohol, mint,
spicy foods, caffeine, and acidic foods.
● Consuming smaller, more frequent meals as opposed to larger meals may reduce
reflux as well.
● Accurate anthropometric measurements are also helpful in assessing whether the
reflux may be related to obesity, as increasing BMI has been shown to be associated
with increasing GERD symptoms.
● Quitting smoking and wearing loose-fitting clothing may be beneficial.
● Notably, waiting at least 3 hours after eating to lie down and elevating the head of
the bed have been shown to decrease reflux.
● Patients may need instruction on meal timing and meal planning to improve satiety
and avoid late night meals and snacks.
, DUMPING SYNDROME
Dumping syndrome describes a range of symptoms that occur when stomach contents are
released too quickly and in too large of a volume into the small intestine.
This creates a hyperosmolar overload, which the body overcompensates for by drawing
excess fluid into the intestine.
DS is subdivided into two forms: early and late
Symptoms
● The typical GI symptoms—abdominal pain, bloating, nausea, vomiting, and explosive
diarrhea—occur as a direct result of the hyperosmolar content and influx of fluid into
the intestine.
● Vasomotor symptoms include headache, flushing, fatigue, dizziness, perspiration,
palpitations, and hypotension,and are likely the consequence of hormone
fluctuations.
Treatment
● Pharmacologic agents like acarbose and octreotide can be used to correct
hypoglycemia, delay gastric emptying, decrease postpran- dial vasodilation, and
increase the absorption of water in the intestine.
● Foods that exacerbate symptoms and should be avoided are those containing lactose
or the simple sugars sucrose, fructose, or sugar alcohols.
● Carbohydrate intake should instead consist primarily of complex carbohydrate
choices. Including protein and fat at each meal in increased amounts will
counterbalance the caloric deficit created by the decreased carbohydrate intake.
● It is crucial that patients continue to meet daily energy needs to avoid unintentional
weight loss.
● Distributing daily intake into small, frequent meals, along with slow and thorough
chewing, will help to prevent large amounts of undigested foods from reaching the
small intestine too quickly.
● Fluid intake should be limited, if not completely restricted, during mealtimes.
● It may be helpful for patients to lie in the supine position postprandially to delay
gastric emptying and minimize vasomotor symptoms.
● For those who experience severe hypoglycemic episodes, supplementation of dietary
fibers has been proven effective to delay glucose absorption and prolong transit
time.
IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome is a functional GI disorder characterized by recurrent abdominal
pain and altered bowel habit.
The main contributing factors of IBS are
● Abnormal GI motility
● Visceral hypersensitivity
● Altered brain-gut communication
● Psychosocial factors: depression, anxiety, and/or somatization
The relationship among irregular gut motility, sensation, and the brain is dependent on the
enteric nervous system and its regulation of the GI system.
GASTROESOPHAGEAL REFLUX DISEASE
Gastroesophageal reflux disease (GERD) is a common digestive disorder, with estimated
prevalence between 10% and 20% in the Western world.
It is characterised by a relaxed or weakened lower esophageal sphincter, which is now open
and allowing reflux to occur.
Symptoms
● Symptoms of GERD include heartburn and regurgitation of stomach acid.
● Other symptoms may include abdominal pain, bad breath, epigastric pressure,
cough, sore throat, dental erosions, wheezing, or difficulty swallowing.
Over time, untreated GERD can lead to erosive esophagitis, pulmonary disease, esophageal
adenocarcinoma, Barrett’s esophagus, and peptic stricture.
Medical and surgical treatment
● Medical treatment of GERD typically involves the use of acid-suppressing
medications, such as proton-pump inhibitors (PPIs).
● If the patient’s symptoms do not improve with medical therapy, surgical options may
be considered.
● A Nissen Fundoplication is a procedure where the top portion of the stomach is
wrapped around the lower esophagus to improve the integrity of the lower
esophageal sphincter and reduce reflux.
● For morbidly obese patients, gastric bypass may be recommended as a treatment for
GERD.
Nutrition Assessment and intervention
● When a patient complains of reflux, it is helpful to get a detailed dietary recall in
order to assess any potential trigger foods in the diet.
● Foods that may cause increased reflux include fatty foods, chocolate, alcohol, mint,
spicy foods, caffeine, and acidic foods.
● Consuming smaller, more frequent meals as opposed to larger meals may reduce
reflux as well.
● Accurate anthropometric measurements are also helpful in assessing whether the
reflux may be related to obesity, as increasing BMI has been shown to be associated
with increasing GERD symptoms.
● Quitting smoking and wearing loose-fitting clothing may be beneficial.
● Notably, waiting at least 3 hours after eating to lie down and elevating the head of
the bed have been shown to decrease reflux.
● Patients may need instruction on meal timing and meal planning to improve satiety
and avoid late night meals and snacks.
, DUMPING SYNDROME
Dumping syndrome describes a range of symptoms that occur when stomach contents are
released too quickly and in too large of a volume into the small intestine.
This creates a hyperosmolar overload, which the body overcompensates for by drawing
excess fluid into the intestine.
DS is subdivided into two forms: early and late
Symptoms
● The typical GI symptoms—abdominal pain, bloating, nausea, vomiting, and explosive
diarrhea—occur as a direct result of the hyperosmolar content and influx of fluid into
the intestine.
● Vasomotor symptoms include headache, flushing, fatigue, dizziness, perspiration,
palpitations, and hypotension,and are likely the consequence of hormone
fluctuations.
Treatment
● Pharmacologic agents like acarbose and octreotide can be used to correct
hypoglycemia, delay gastric emptying, decrease postpran- dial vasodilation, and
increase the absorption of water in the intestine.
● Foods that exacerbate symptoms and should be avoided are those containing lactose
or the simple sugars sucrose, fructose, or sugar alcohols.
● Carbohydrate intake should instead consist primarily of complex carbohydrate
choices. Including protein and fat at each meal in increased amounts will
counterbalance the caloric deficit created by the decreased carbohydrate intake.
● It is crucial that patients continue to meet daily energy needs to avoid unintentional
weight loss.
● Distributing daily intake into small, frequent meals, along with slow and thorough
chewing, will help to prevent large amounts of undigested foods from reaching the
small intestine too quickly.
● Fluid intake should be limited, if not completely restricted, during mealtimes.
● It may be helpful for patients to lie in the supine position postprandially to delay
gastric emptying and minimize vasomotor symptoms.
● For those who experience severe hypoglycemic episodes, supplementation of dietary
fibers has been proven effective to delay glucose absorption and prolong transit
time.
IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome is a functional GI disorder characterized by recurrent abdominal
pain and altered bowel habit.
The main contributing factors of IBS are
● Abnormal GI motility
● Visceral hypersensitivity
● Altered brain-gut communication
● Psychosocial factors: depression, anxiety, and/or somatization
The relationship among irregular gut motility, sensation, and the brain is dependent on the
enteric nervous system and its regulation of the GI system.
